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Rishi- Cardio > Structural Heart Disease > Flashcards

Structural Heart Disease Flashcards

1
Q

What are the 4 congenital heart diseases?

A

Coarctation of aorta
Tetralogy of fallot
Atrial septal defect
Ventricular septal defect

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2
Q

How do ventricular and atrial septal defect work?

A

There is a hole in the septum causing oxygenated blood to become mixed with deoxygenated blood

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3
Q

What does coarctation of the aorta do to stroke volume and cardiac output?

A

Decreases it

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4
Q

What are the abnormalities of tetralogy of fallot?

A

Pulmonary stenosis
RVH- due to PS
Ventricular septal defect
Overriding aorta

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5
Q

What precedes aortic stenosis and what causes it?

A

Aortic sclerosis
Valve narrowing due to leaflet fibrosis and calcium deposits on valve

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6
Q

What are the causes of aortic stenosis
What is its pathophysiology with and without rheumatic disease?

A

Rheumatic fever
Congenital heart disease- bicuspid aortic valve
Calcium build up

Inflammation and damage leads to fibrosis and calcification of valve = stenosis

Autoimmune inflammatory reaction to streptococcus infection targeting valvular endothelium (endocardium) = calcification

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7
Q

How does aortic stenosis present?

A

Dyspnoea- difficulty breathing
Angina
Fatigue
Syncope- fainting
Ejection systolic murmur
Systolic heart failure
High lipoprotein and high LDL

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8
Q

Why can aortic stenosis cause systolic heart failure

A

Systolic heart failure = heart failure specific to left ventricle
The prolonged high pressure in the LV = LVH, this leads to dilation after some time due to the increased pressure and = systolic heart failure

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9
Q

What are the management techniques for aortic stenosis?

A

AVR
Statins
Balloon aortic valvuloplasty

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10
Q

What is aortic regurgitation?
What are its causes?

A

Diastolic leakage from aorta to ventricle
Rheumatic fever
Congenital
Infective endocarditis
Marfans syndrome
Ankylosing spondylitis

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11
Q

What is the pathophysiology of aortic regurgitation via infective endocarditis and other?

A

Bacterial vegetation on valve causing rupture or perforation of leaflets or dilation of valve due to aortic root dilation
Can also be fibrosis and calcification

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12
Q

How does aortic regurgitation cause cardiogenic shock?

A

Can’t blood properly due to the increased blood volume in LV (and LVH) causing heart failure and ultimately cardiogenic shock

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13
Q

Why does aortic regurgitation affect ejection fraction?

A

At first its normal but due to LVH ejection fraction decreases

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14
Q

How does aortic regurgitation present?

A

Cardiogenic shock
Early-diastolic murmur: austin flint murmur
Dyspnoea
Tachycardia

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15
Q

What is the management of aortic regurgitation?

A

AVR
Vasodilatory therapy
Treat rheumatic fever or infective endocarditis

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16
Q

What are the causes of mitral stenosis?

A

Rheumatic fever
SLE
Drugs

17
Q

How can mitral stenosis cause hemoptysis?

A

Increased LA pressure leads to pulmonary hypertension due to backflow into pulmonary veins = fluid in lungs transudates into interstitium from pressure gradient = bronchial vein ruptures = hemoptysis (coughing up blood)

18
Q

How does mitral stenosis cause decreased cardiac output?

A

Decreased LV filling causes the decreased cardiac output

19
Q

How does mitral stenosis cause right sided heart failure?

A

Blood cannot drain into the left side of the heart due to the valve, meaning it stays in the pulmonary system. This means that eventually there is RVH and causes the heart failure (note this happens secondary to left sided heart failure)

20
Q

What are the presentations of mitral stenosis?

A

Hemoptysis
Mid-diastolic murmur
Dyspnoea
History of rheumatic fever
Right sided heart failure

21
Q

How do you manage mitral stenosis?

A

AVR
Balloon valvotomy
BB

22
Q

What are the causes of mitral regurgitation?

A

Rheumatic heart disease
Infective endocarditis
Hypertrophic cardiomyopathy

23
Q

How does mitral regurgitation end in decrease end-systolic volume?
How does it affect preload and afterload?

A

Less blood flow into LV causing LVH, causing an increase in preload but decreasing afterload as the blood now has two directions it can go in, increasing end diastolic volume and decreasing end systolic volume

24
Q

How does mitral regurgitation present?

A

Holodiastolic murmur
Dyspnoea
Chest pain
Fatigue
Decreased end systolic volume but increases systolic end volume
Increased preload and decreased afterload

25
Q

How do you manage mitral regurgitation?

A

MVR
ACE inhibitors
BB

26
Q

What is dilated cardiomyopathy?
What are the causes?

A

Ventricular chamber enlargement with normal left ventricular wall thickness
Heart valve disease
Thyroid disease
Myocarditis
Alcoholism

27
Q

How does dilated cardiomyopathy cause contractile dysfunction?

A

Increased LV size causes heart to have to pump with more force to get blood out, this becomes overwhelming and eventually fails as muscles aren’t strong enough

28
Q

How does dilated cardiomyopathy present?

A

Dyspnoea
Heart murmur
Fatigue
Angina
Low cardiac output

29
Q

How do you treat dilated cardiomyopathy?

A

Diet- decrease Na+ and fluid
Treat underlying conditions
Bb, ace inhib

30
Q

What is hypertrophic cardiomyopathy?
Why does it cause sudden death?

A

Autosomal dominant genetic disease increasing LV wall thickness or septal thickness= obstructed blood flow

Often asymptomatic - first symptom is ventricular fibrillation

31
Q

How do you manage hypertrophic cardiomyopathy?

A

BB
Septal myectomy

32
Q

What is restrictive cardiomyopathy?

A

Atrial enlargement due to impaired ventricle filling due to stiff muscles but ventricle size was normal

33
Q

What are the causes of restrictive cardiomyopathy?

A

Troponin mutations
Haemochromocytosis
Amyloids
Sarcoidosis

34
Q

What is the pathophysiology of restrictive cardiomyopathy?

A

Deposition of abnormal substances on heart tisse causing stiffening of the ventricular walls and myocardium

35
Q

How does restrictive cardiomyopathy present?

A

Hepatomegaly
Comfort in sitting
Weight loss
Reduced cardiac output
Increasing jugular venous pressure

36
Q

How is restrictive cardiomyopathy managed?

A

BB Ace inhib
Immunosuppressants- troponin
Heart transplant

Rishi- Cardio (4 decks)

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